Individual
DIVYA GOPALAN VENKAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4646 JOHN R ST, DETROIT, MI 48201
(313) 576-1000
Mailing address
4646 JOHN R ST, DETROIT, MI 48201-1916
(313) 576-1000
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
4301109156
MI
207RP1001X
Pulmonary Disease Physician
Primary
4301109156
MI
Other
Enumeration date
07/06/2010
Last updated
05/16/2019
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